Two wonderful videos featuring rural doctors and their patients

 

The passionate country doctors featuring in these videos with their patients are great examples for rural general practice. Warning: After watching the interviews you may feel the sudden urge to pack your bags and move to the country.

Dr Ken Wanguhu: “Being a GP has taught me that there is a lot more to medicine than disease… It goes beyond the disease to the patient and their family and to the community, and that’s general practice.”

The second video features Dr Mel Considine and her patient Phil from rural South Australia. Phil: “And the first thing I remember was this lovely lady leaning over me, and she said ‘I’m Doctor Mel, the duty doctor today, and I’m here to look after you.'”

Everybody has an opinion about their GP

Do you know that situation – usually at a party – when someone tells you what they do for a living, and mention a cool sounding job description like ‘product innovation manager’ or ‘advertising account executive’? I always want to know: what does that mean and what do you actually do?

Well, people never ask me what I do when I say I’m a GP. Instead, they usually tell me what their GP does. Or did. Or said.

Everybody always knows what I do, and that’s not surprising because the Australian general practice statistics are mind-blowing: Over 134 million GP consultations take place each year. Every year almost 9 out of 10 Australians make at least one contact with a general practitioner.

Professor Max Kamien said in the latest BEACH study:

“Mothers, children, the elderly and those with chronic conditions, such as diabetes, asthma and hypertension, have many more contacts than that. As a result of these personal contacts everyone has a view about general practice. Ministers of Health have been known to base their views about general practice on their contact with their own GP.

I’m privileged to have a job that’s smack-bang in the middle of life. One could indeed argue that we’re specialists in life, as we deal with just about everything: mental health, paediatrics, cancer, skin disorders, respiratory problems, grief, heart failure, domestic violence, emergencies, pregnancy, end-of-life care, immunisations, screening… you name it.

The latests RACGP commercial tells the story of diversity – the diversity of GPs, their patients and their conditions. I love the commercial because it captures in 60 seconds the wide range of issues people bring to the consulting room of the family doctor.

So if you want to find out what really happens in my office, have a look at this video.

Are you a leader, a follower, or both?

To lead people, walk behind them ~ Lao Tzu

When talking about the success of organisations, businesses or political parties, we often focus on leaders and leadership, but what about the followers? I’d argue that followers are just as important. There are no leaders without followers, and good leaders often have great followers. Yet, followership is an undervalued concept.

Robert E. Kelly was one of the first researchers who pioneered the theory of followership. He proposed 5 categories of followers:

  1. The sheep, who are passive and look to the leader for directions and motivation.
  2. The yes-people. They are more active and positive, but still look to the leader for direction and vision.
  3. Alienated followers think for themselves, but lack positivity. They often come up with many reasons why their leader or organisation is going in the wrong direction.
  4. The pragmatics are fence sitters. They will follow, but only if others follow first and it is clear where the leader or organisation is heading.
  5. Star followers are positive, independent thinkers. They are effective followers who will support their leaders if they agree, but will also challenge leaders if they disagree, offering constructive feedback.
Followership matrix
Followers in the upper right corner of the matrix are just as valuable as leaders. Source: In Praise of followers (Kelly, 1988)

Are you a good follower?

The success of an organisation depends partly on how well its leaders lead, but partly also on how well its followers follow. Most of us spend the majority of our time following others in one way or another. But we’re not always good at it. So how do you know if you are a good follower? And can we become better at it?

Star followers are sometimes viewed as ‘leaders in disguise’. According to Kelly, effective followers share the following qualities:

  • They think independently and can work without close supervision
  • They are committed to their organisation and to a purpose, principle, product or idea
  • They build their competence and focus their efforts for the greatest impact
  • They are courageous, honest, and credible.

Effective followers keep their leaders honest. Yet, followership has a negative connotation, almost to the point where it is seen as a weakness instead of a strength. But being a follower is more than just doing what you’re told. Kelly: “(…) our stereotype is ungenerous and wrong. Followership is not a person but a role, and what distinguishes followers from leaders is not intelligence or character but the role they play.”

Followers are leaders

In addition to the many available leadership courses, we should consider creating more followership training opportunities, focussing on topics like:

  • Improving independent, critical thinking
  • Self-management
  • Disagreeing agreeably
  • Building credibility
  • Aligning personal and organisational goals and commitments
  • Acting responsibly toward the organisation, the leader, coworkers, and oneself
  • Similarities and differences between leadership and followership roles
  • Moving between the two roles with ease.

If an organisation does not succeed, often its leaders are publicly criticised or changed. But there are alternatives. Having read Kelly’s classic publication ‘In praise of followers‘, it seems that becoming a better follower is an empowering experience.

Online therapy? It works.

Mental health care is not accessible to everyone. It’s a fact that less than fifty percent of people who need treatment actually get it. But access to an internet connection is available to most people. So it makes sense to offer more health services online.

Although the opinions are divided about Dr Google, health experts now agree on one thing: internet therapy for many mental health problems works.

5 benefits

E-mental health is a broad term used for mental health services delivered via internet programs, telehealth, mobile phone applications and websites. There are five benefits:

  1. It can be accessed anytime and anywhere
  2. There are no or low costs to patients
  3. It fills service gaps
  4. It reduces wait lists
  5. It’s cost-effective to the health system.

Some patient groups will benefit less from online therapy, such as people with complex or severe mental illness, personality disorders, substance dependence, or people who have a higher risk of self-harm or suicide and need urgent clinical management.

Who is it for?

E-mental health probably works best for people at risk of illness or people with mild to moderate symptoms. It is used in many ways including first-line treatment and relapse prevention. Evidence shows that it can be as effective as face-to-face therapy. Using the services in combination with regular visits to a doctor is ideal.

If you want to know what e-mental health services are available and how reliable they are, click here (free registration). The site uses a smiley system to show how much evidence there is that a service works.

More information and free e-mental health training for health professionals can be found here. The RACGP has published a handy e-mental guide for GPs.

Have a look at the video as well. Before you use any of the online services it is recommended to check the terms and conditions so you know what happens with the personal information you provide.

Sources:

Our story, our vision – the future of general practice

We now have an excellent vision for a sustainable Australian healthcare system and general practice.

The final version of the vision was released by RACGP president Dr Frank Jones at the GP15 conference in Melbourne this week. It is based on feedback from over 1,000 GPs, stakeholders and consumer groups.

There are 2 elements of the vision that make it remarkable:

#1: the medical home

A stable and enduring relationship between a patient and a GP has a positive impact on health outcomes. The medical home encourages voluntary patient registration with a preferred practice. It will benefit patients and doctors as it allows for continuity of care and effective, better-targeted coordination of care to meet patient needs.

Patients may choose whether to enrol with a practice of their choice. Likewise, GPs and practices may choose to take part in the program.

Patients will be able to visit any general practice for standard care, but chronic disease management, integration of care and preventive health will be limited to their medical home.

#2: a new funding model

The RACGP proposes a major overhaul of the current funding system. It’s a flexible model and includes support for GPs and their teams to deliver multidisciplinary teamwork and coordination work on behalf of their patients.

A comprehensiveness payment made to a practice would recognise the practices and practitioners that provide a broad range of services to the community.

The current PIP and SIP regimes need to be replaced by practitioner support and practice support payments as outlined in detail in the vision document.

The story of general practice is told in this new RACGP video, spoken by Sigrid Thornton.

Minister, please don’t ruin our holiday again

Before Christmas – just as I was about to pack my suitcase – Prime Minister Tony Abbott dropped a bomb.

Together with the Health Minister he announced that the Government had introduced a policy to stop 6-minute medicine – or ‘sausage machine medicine’ as he called it. As a result the Medicare rebate would be reduced in January by $20 for GP consultations of less than 10 minutes.

Battle won, but not the war

This cut to Medicare patient rebates was meant to deliver $1.3 billion in savings over four years. However, as a result of the backlash by GPs and health consumers, the proposal has now been scrapped.

The other 2 components of the Government’s revised co-payment plan are still on the table: $873 million saving from a $5 Medicare rebate cut, and $1.3 billion saving by a four-year freeze of Medicare fees for GPs, medical specialists, optometrists, and others.

Expect more fireworks in the coming months.

6-minute medicine

Was Abbott right about the sausage machine? Are bulk-billing doctors churning through patients in six-minute sessions?

Most GPs felt Abbott’s argument was a sham as the issue was never raised in the budget. The real agenda was obviously to save health dollars. The timing – just before the Christmas break – as well as the one month’s notice before the measure would kick in, added insult to injury.

Some said it was a case of attempted political suicide.

Research shows that the average GP consultation lasts 14 minutes, not six. Some consultations may only take 5 or 6 minutes, but that’s not necessarily a bad thing. Here’s an example:

Someone comes in with a painful wrist after a fall. An efficient, experienced GP can take a history, examine the wrist and, if needed, organise further investigations within 6 minutes. The GP-in-training may take 20 minutes to do the same, should she be paid more? Probably not.

Abbott’s argument is of course not coming out of the blue: ‘6-minute medicine’ has a bad reputation because some business models of larger corporate GP clinics are purely profit-driven, and it is thought that this can lead to a high patient-turnover.

If Abbott has a problem with this practice, his Government should deal with those clinics, and not punish all GPs and their patients. But there’s more to it.

The real problem

The real problem is the increasing gap between the Medicare rebate and the costs of running a practice. While business expenses are going up every year, Medicare has only slightly increased the rebates over the years – barely covering inflation, and for the past 1.5 years the rebate has been frozen.

As a result, doctors need to see more patients per hour or work more hours, if they want to continue bulk billing. Another option is to retire (not recommended). Or they can choose to charge a gap fee or co-payment. This has happened before.

In 2003 bulk billing rates were at an all-time low of 66%. This didn’t make the Howard Government very popular, so the health-minister – Tony Abbott – had to increase the Medicare rebates. As a result, bulk billing went up again.

The solution

At the moment bulk billing rates are at an all-time high, about 85%. If the planned $5 rebate cut and freeze per the 1st of July 2015 go ahead, it is likely that less clinics can afford to bulk bill. History tends to repeat itself: If voters start to complain at a level of about 66% the Government may feel there is room to play – that is if they can get their proposals through the senate.

The new Health Minister Sussan Ley indicated after the backdown last week that she will continue to look for ways to make Medicare ‘sustainable’ and introduce a price signal by way of a co-payment. At the same time she wants to protect bulk billing and maintain and improve high quality healthcare.

I just hope that whatever the solution will be, private insurers are kept at a distance.

It’s good to hear that Minister Ley will talk to doctors – she seems genuine. Many GPs have already started the debate about ways to cut red-tape and increase efficiency in primary care. I’ve heard some excellent suggestions.

A bottom-up approach to health reform takes longer, but is more likely to succeed.

Everything you always wanted to know about bulk billing (Video)

My patients often ask: “Doctor, do you  bulk bill?” and “Why do I have to pay a gap?”

Although there are certainly circumstances where I bulk bill, it has many risks. Lowering the quality of Australian Family Doctor services is one them. In this video I have tried to explain how it all works.